Healthcare Provider Details

I. General information

NPI: 1831596980
Provider Name (Legal Business Name): MONICA CISNEROS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 S PULASKI RD
CHICAGO IL
60623-5095
US

IV. Provider business mailing address

1 CAMBERLEY CT
HINSDALE IL
60521-4564
US

V. Phone/Fax

Practice location:
  • Phone: 773-762-3333
  • Fax: 773-922-5203
Mailing address:
  • Phone: 773-762-3333
  • Fax: 773-922-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038012729
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038012729
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038012729
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038012729
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: